ABSTRACT

The prevalence of viral hepatitis B among patients in National Orthopedic Hospital Enugu was studied. The samples comprised that of men , woman and children 200 in numbers, all patient of orthopedic Hospital Enugu. Laboratory investigation done were this HBs  tested which 110 patient out of the 200 patients tested positive,  and liver function tests found abnormal in almost all the patients that tested positive to HBsAG routine test. The commonest clinical presentations were fever and jaundice seen in Jo patient out of the 110 patients. The infection was  highest amongst young adult 21-30 years of age. This accounted for 17.5% of the positive patients population it was lowest amongst children 1-10 and old people 60-70 which  made up 5% of the infected population. The study also gave the general view of the group of individual affected whether children or adult, and the wid expired of the repetitious B. Hepatitis B one of the major cause of human suffering in the world despite a though understanding of its transmission and prevention and control by use of vaccine was found to be prevalent in National Orthopedic Hospital Enugu among the patients.

CHAPTER ONE

INTRODUCTION

1.1     INTRODUCTION TO HEPATITIS B

Viral hepatitis is a disease as old as the history of Medicine. Hepatitis was described in the Babylonian Talmud in the fifty century BC, and was referred to by Hippocratic over 2000 years ago. Despite this ancient knowledge, it was not until 1963, that the first human Repetitious virus was isolated, Hepatitis B. This was followed quickly by the purification of Hepatitis A in 1973, and more recently by the isolation of viruses C, D, E and G. These viruses are known to infect the human liver (Anderson et al; 2001).

However, there are more than twenty other viruses, which infect the human liver. These are not considered “Repatitis viruses” as these other viruses tend to infect organs other than the liver more seriously’. These include common viruses such as Cytomegalovirus (CMV), Mumps, Rubella, Epstein-Barr virus (EBV) as well as rare ones such as Rassa fever and yellow fever viruses.

Any infection that results in inflammation of the liver is called Repatitis (Greek Repaticus, liver). Incidentally, not all “hepatitis” is caused by viruses. “HEPATITIS” means “inflammation of the liver”, and can be caused also by other types of infection (bacteria fungi etc); toxic drugs; poisons; alcoholism and so on (Drexott etal; 2005).

But of interest is one Repatitis virus – one of the most common infections diseases, causing an estimated 1.5millon deaths world wide each year – Hepatitis B. Hepatitis B is caused by the Repatitis B virus (HBV), a double – stranded circular DNA virus of complex structure. Hbv is class ivied as an orthoropadnavirus within the family hepadnaviridae. HBV was originally recognized as the age responsible or serum Repatitis the most common form of partially transmitted viral Repatitis and an import cause of acute and chronic infection of the liver. This why hepatitis b is some times called seum Repatitis. The virus was formerly and anilines referred to as Australian antigen. The reason being that it was first isolated room the blood of an Australian aborogie and is associated with HBV. (procott et al 2005.

Hepatitis B remain one of the major cause of human suffering in the world despite a through understanding of its transmission and prevention. Serum form undivided infected with hepatitis B contains three district antigen  particles: a spherical 22nm particle, a 42 nm  spherical particle ( counting DNA  and DNA polymer able) called  the Dane particle, and tubular or filamentous particles that vary in length. The small spherical and tubular particles  are the unassembled component of the Dane particle- the infective form of the virus. The unassembled particles. Contain hepatitis B surface antigen (HBsAg) whose presence in the blood is (a) an indicator of Repatitis B infection (b) the basis for the large scale screening of blood for the hepatitis B virus, and (c) the basis for the first vaccine for human use developed by recombinant DNA technology (Evans, 1997

The Hepatitis B virus is normally transmitted through blood transfusion, contaminated equipment, drug users unsterile needles, or any body secretion (saliva, soren, sweat, breast milk, urine)  The virus also can pass from the blood of an infected mother through the placenta to infect  the fetus. Each year an estimated 200, 000 people in Nigeria are infected with Australian Antigen (HBV) about 1000 person die yearly from hepatitis related cirrhosis and about 5000 die from HBV related liver cancer. (HBV is second only to tobacco as a known cause of rumen cancer). Worldwide, HBV infects over 200 million people (Schlesinger & Schlesinger, 2001). The clinccal signs of Repatitis B vary widely, most cases are symptomless. However, sometime fever, loss of appetite, abominal discomfort, nausea, fatigue, and other symptoms gradually appear following an incubation period of 1 to 3 months. The virus infects liver Hepatic cells and causes liver tissue degeneration and the release of liver associated enzymes (transaminases) into the blood team. This is followed by jaundice, the accumulation of bilirubin (a breakdown product of raemoglobin in the skin and other tissue with a resulting yellow appears. The distinctive yellow jaundice the Hepatitis B usually imparts to its victims  skin has  made it an rasity detectable disease through recorded history. Frequently, acute hepatitis B in anicteric and symptomatic, although acute liver failure may develop. The virus persists in about 10 percent of infected immouno compent adults, and in as many 90 percent of infants infect peninatally depending on the ethnic group of the mother. About 350 million people worldwide are persistent carries of hepatitis B. actually one in twenty infection results in chronic hepatitis, defined as persistent hepatitis virus six mouths after the onset of the acute illness. Chronic HBV infection can be entirely begin with normal liver blood tests (“Chronic Carrier State”) or may be an aggressive inflammatory process (“Chronic active hepatitis”), which can lead to severe scarring (“Cirrhosis).

Approximately 25 percent of all patients with chronic hepatitis will progress to cirrhosis and about 20 percent of those with cirrhosis will develop hepatocellular carcinoma. That is to say, the risk of liver cancer (hepatoma) is high in cirrhosis caused by HBV.

Hepatocellular carcinoma is one of the most common cancers worldwide (Seeger & manor; 2000)

During the first phase of chronicity, virus replication continues in the liver and replicative intermediates of the viral genome may be detected in DNA extracted from liver hiopsies. Makers of virus replication in serum include HBVDNA (this indicated virus presence and activity), DNA polymerize (determines the presence of HBVDNA in liver cell, and a soluble antigen, hepatition.be antigen (\HbeAG), which is secreted by productively infected hepatocytes. In those infected at a very going age this phase may persist for life but, more usually, virus levels decline over time. Eventually, in most individuals, there is immune clearance of infected hepatocytes associated with seroconverision low replication, the viral senome may integrate into the chromosomal DNA of some hepatocytes and these cells may persist and expand closely. Rarely , seroconversion to anti-HBs follows clearance of virus replication but, more frequently, HBSAg persists during a second phase of chronicity  as a result of the expression of integrated viral DNA.   

 VIRAL REPLICATION

 With respect to replication of the HBV, the fundamental  process of viral infection is the expression of the viral replication cycle in a rost cell. The steps for the infection process involving HBV usually include the following:

Enter a host

-         contact and enter susceptible cell.

-         Replicate within the cell.

-         Sprea d to adjacent cells.

-         Cause cellular injury.

-         Engender a host immune response

-         Be either cleared from the body of the host, establish a presistnt infection , or kill the host.

-         Be shed  back into the environment (prexote it al; 2005).

VIRAL SPREAD            

Mechanisms of viral spread very, but the most roates include bloodstream. The presence of viruses in the  blood is called VIREAMA>HBV is spread through blood, body secretion, needles, placenta as well as sexually. This os to say that transmission as through parental routes. Therefore, transmission of HBV can occur from  person to person as  a result of transfer of blood by any prouder which breaks the skin or mucous members HBV spread mainly parentally, in most cases seen in adults , HBs (Australian Antigen) has been identified in almost every body fluid f infected persons- saliva tears semen, cerebrospinal fluid, ascetic fluid, breast milk synovial fluid, gastric juice, urine and rarely in faces. This disease is, therefore, a major occupational hazard of medical personnel. It is commonly  seen in people  who receive multiple blood transfusion or blood product intravenous drug abusers, homosexuals and the sexually promiscuous.

1.2                      PURPOSE OF STUDY

The need for study can never be over emphases having considered the above, this study serves the following purpose  or objectives.

1.                 To  obtain a general view of the group of individual affected whether children or adults.

2.                 To show circumstances which dispose to viral hepatitis and suggest means of reducing the incidence.

3.                 To review the management of these patients with regards to vestigation done and treatment.

4.                 To understand the complex or exorbitant nature of the structure of the hepatitis B virus as well as the debilitating effect it has on the patient

5.                 Also compare and contrast primary data from this study with secondary from the library

6.                 To how rate of progression to chronicity as well as make known the daily activities that will not result in contacting HBV.

1.3                      SIGNIFIGANCE OF STUDY

This study done to known the existence or widespread of this disease among patience in Nation Orthopedic Hospital Enugu. Or to understand and show the prevalent Hospital in question .the significance of this study can never be over emphasicum this is because in developing countries such as HBV is indisputable essential in the life of that country especially in their hospitals. Many children are infected by hepatitis B virus at on early age a significant portion of apparently healthy individual are chronic carriers of HBsAg, that is the Australia Antign. The significance of this study is seen in the light of having a better knowledge and understanding or better still widening our scope of the chronically and pathogenically of HBV.

4.1            STATEMENT OF PROBLEM

A study of this nature surely must have problem which result in it. Hepatitis B is a viral disease that is spread through all  body fluids, that is to say that one can contact this disease by exchange to body fluid with    infected person.  Looking at our society and hospital there are cases where by  unscreened blood is transfixed to a patient case of multiple sex  partner people having unprotected sex, making use of sharp objects without any care. All these dispose to viral hepatitis B. and gives risk to a study of such .

1.5            LIMITATON/ SCOPE OF STUDY

As a result of time factor, the scope of this study was narrowed down to fit Witter the time limit. Due to this fact, this study was lenicted  only among patients in National Orthopedic Hospital Enugu. There fore, the scope or the delimitation, which infect in the area of coverage of this study is National Orthopedic Hospital Enugu.

1.6            HYPOTHESIS

H0      Hepatitis B is prevalent among patients in National Orthopedic

Hospital Enugu.

H1         Hepatitis B is not prevalent among patients in National

       Orthopedic Hospital Enugu.